The DOI matches its Crossref record; 29 of the 29 references it cites were found in a registry or an index.
Predicting adoption of exposure therapy in a randomized controlled dissemination trial
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
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“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
In the citing paper
“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
In the citing paper
“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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Citations
Cites
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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
A Meta-Analytic Review of Adult Cognitive-Behavioral Treatment Outcome Across the Anxiety Disorders
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Motivational Interviewing: Preparing People for Change
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Cited by
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Frank, H. E., Becker‐Haimes, E. M., & Kendall, P. C. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12330 · Cited by 327
Waller, G., & Turner, H. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.005 · Cited by 256
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
Boeldt, D., McMahon, E., McFaul, M., & Greenleaf, W. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00773 · Cited by 242
“Directly addressing clinicians’ concerns increases adoption as does training that incorporates motivational enhancement and/or offers a supportive learning community (22, 27).”
BackgroundFarrell, 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
Metadata
- 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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