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The Impact of Australian Psychologists’ Education, Beliefs, Theoretical Understanding, and Attachment on the Use and Implementation of Exposure Therapy

Published online by Cambridge University Press:  13 August 2020

Clancy Rowe  and
Maria Kangas Open the ORCID record for Maria Kangas [Opens in a new window]
Clancy Rowe
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
Maria Kangas*
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
*
*Corresponding author: Maria Kangas, Department of Psychology, 4-First Walk, Macquarie University, North Ryde, NSW2109, Australia. Email: [email protected]
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Abstract

The objective of this study was to investigate the relative contributions of university education, exposure specific training, and beliefs about exposure therapy (ET) in relation to the frequency, duration, and intense delivery of ET by Australian psychologists. Associations between clinicians’ use of and theoretical conceptualisation of ET, and attachment style were also evaluated. A total of 115 Australian psychologists (N = 94 females) completed an online survey. Findings revealed that a majority of participants used cognitive behaviour therapy (93%) and ET (88%) to treat anxiety disorders, including obsessive-compulsive disorder. The majority who used ET (90%) reported using therapist-assisted in vivo exposure with clients. Findings also showed that therapists spend 42% of session time on exposure. Moreover, therapists who reported more comprehensive training had more positive beliefs about ET. Positive beliefs about ET, and clearer conceptualisation of treatment, were related to greater use and more intense implementation of ET. Psychologists with a more preoccupied or dismissive attachment style were less likely to deliver intense ET. The findings suggest that ET-specific training may be a powerful medium to improving the adoption and application of ET. Clinician's theoretical conceptualisation of ET and interpersonal attachment style are also worthy targets for future research and training in ET.

Keywords

exposure therapytrainingbeliefsmechanisms of changeattachment style
Type
Standard Paper
Information
Behaviour Change , Volume 37 , Issue 3 , September 2020 , pp. 151 - 170
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Abramowitz, J (2013). The practice of exposure therapy: Relevance of cognitive-behavioral therapy and extinction theory. Behavior Therapy, 44, 548–558.CrossRefGoogle ScholarPubMed
Abramowitz, J, Deacon, B and Whiteside, S (2012). Exposure therapy for anxiety: Principles and practice. New York, NY: Guildford Press.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
Becker-Haimes, EM, Okamura, KH, Wolk, CB, Rubin, R, Evans, AC and Beidas, RS (2017). Predictors of clinician use of exposure therapy in community mental health settings. Journal of Anxiety Disorders, 49, 88–94. doi:10.1016/j.janxdis.2017.04.002.CrossRefGoogle ScholarPubMed
Becker, CB, Zayfert, C and Anderson, E (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292. doi:10.1016/S0005-7967%2803%2900138-4.CrossRefGoogle ScholarPubMed
Birnbaum, G, Orr, I, Mikulincer, M and Florian, V (1997). When marriage breaks up: Does attachment style contribute to coping and mental health? Journal of Social and Personal Relationships, 14, 643–654.CrossRefGoogle Scholar
Britton, P and Fuendeling, J (2005). The relations among varieties of adult attachment and the components of empathy. Journal of Social Psychology, 145, 519–530.CrossRefGoogle ScholarPubMed
Cassidy, J, Shaver, P, Mikulincer, M and Lavy, S (2009). Experimentally induced security influences responses to psychological pain. Journal of Social and Clinical Psychology, 28, 463–478.CrossRefGoogle Scholar
Cherry, MG, Fletcher, I and O'Sullivan, H (2013). Exploring the relationships among attachment, emotional intelligence and communication. Medical Education, 47, 317–325.CrossRefGoogle Scholar
Clark, D and Beck, A (2010). Cognitive therapy of anxiety disorders: Science and practice. New York, NY: Guildford Press.Google Scholar
Collins, N, Guichard, A, Ford, M and Feeney, B (2006). Responding to need in intimate relationships: Normative processes and individual differences. In Mikulincer, M and Goodman, G (Eds.), Dynamics of romantic love: Attachment, caregiving, and sex (pp. 149–189). New York, NY: Guildford Press.Google Scholar
Craske, MG, Liao, B, Brown, L and Verliet, B (2012). Role of inhibition in exposure therapy. Journal of Experimental Psychopathology, 3, 322–345. doi:10.5127/jep.026511.CrossRefGoogle Scholar
Craske, M, Treanor, M, Conway, C, Zbozinek, T and Vervliet, B (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.CrossRefGoogle ScholarPubMed
Deacon, BJ, Farrell, NR, Kemp, JJ, Dixon, LJ, Sy, JT, Zhang, AR and McGrath, PB (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772–780. doi:10.1016/j.janxdis.2013.04.006.CrossRefGoogle ScholarPubMed
Degnan, A, Seymour-Hyde, A, Harris, A and Berry, K (2016). The role of therapist attachment in alliance and outcome: A systematic literature review. Clinical Psychology and Psychotherapy, 23, 47–65. doi:10.1002/cpp.1937.CrossRefGoogle ScholarPubMed
Elliot, A and Reis, H (2003). Attachment and exploration in adulthood. Journal of Personality and Social Psychology, 85, 317–331.CrossRefGoogle ScholarPubMed
Farrell, NR, Deacon, BJ, Kemp, JJ, Dixon, LJ and Sy, JT (2013). Do negative beliefs about exposure therapy cause its suboptimal delivery? An experimental investigation. Journal of Anxiety Disorders, 27, 763–771. doi:10.1016/j.janxdis.2013.03.007.CrossRefGoogle ScholarPubMed
Farrell, N, Kemp, J, Blakey, S, Meyer, J and Deacon, B (2016). Targeting clinician concerns about exposure therapy: A pilot study comparing standard vs. enhanced training. Behaviour Research and Therapy, 85, 53–59. doi:10.1016/j.brat.2016.08.011.CrossRefGoogle ScholarPubMed
Fisher, PL and Wells, A (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43, 1543–1558. doi:10.1016/j.brat.2004.11.007.CrossRefGoogle ScholarPubMed
Fraley, R and Waller, N (1998). Adult attachment patterns: A test of the typological model. In Simpson, J and Rholes, W (Eds.), Attachment theory and close relationships (pp. 77–114). New York, NY: Guilford Press.Google Scholar
Fraley, R, Niedenthal, P, Marks, M, Brumbaugh, C and Vicary, A (2006). Adult attachment and the perception of emotional expressions: Probing the hyperactivating strategies underlying anxious attachment. Journal of Personality, 74, 1163–1190.CrossRefGoogle Scholar
Fraley, R, Hudson, N, Heffernan, M and Segal, N (2015). Are adult attachment styles categorical or dimensional? A taometric analysis of general and relationship-specific attachment orientations. Journal of Personality and Social Psychology, 109, 354–368. doi:10.1037/pspp0000027.CrossRefGoogle ScholarPubMed
Fritz, H and Helgeson, V (1998). Distinctions of unmitigated communion from communion: Self-neglect and over-involvement with others. Journal of Personality and Social Psychology, 75, 121–140.CrossRefGoogle Scholar
Gola, J, Beidas, R, Antinoro-Burke, D, Kratz, H and Fingerhut, R (2016). Ethical considerations in exposure therapy with children. Cognitive and Behavioral Practice, 23, 184–193.CrossRefGoogle ScholarPubMed
Griffin, DW and Bartholomew, K (1994). Models of the self and other: Fundamental dimension underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430–445.CrossRefGoogle Scholar
Harned, MS, Dimeff, LA, Woodcock, EA and Contreras, I (2013). Predicting adoption of exposure therapy in a randomized controlled dissemination trial. Journal of Anxiety Disorders, 27, 754–762. doi:10.1016/j.janxdis.2013.02.006.CrossRefGoogle Scholar
Harned, MS, Dimeff, LA, Woodcock, EA, Kelly, T, Zavertnik, J, Contreras, I and Danner, SM (2014). Exposing clinicians to exposure: A randomized controlled dissemination trial of exposure therapy for anxiety disorders. Behavior Therapy, 45, 731–744. doi:10.1016/j.beth.2014.04.005.CrossRefGoogle ScholarPubMed
Hayes, S and Hofmann, S (2017). The third wave of cognitive behavioural therapy and the rise of process-based care. World Psychiatry, 16, 245–246.CrossRefGoogle ScholarPubMed
Hembree, EA, Rauch, SAM and Foa, EB (2003). Beyond the manual: The insider's guide to prolonged exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 22–30.CrossRefGoogle Scholar
Hipol, LJ and Deacon, BJ (2013). Dissemination of evidence-based practices for anxiety disorders in Wyoming: A survey of practicing psychotherapists. Behavior Modification, 37, 170–188.CrossRefGoogle ScholarPubMed
Hundt, NE, Harik, JM, Barrera, TL, Cully, JA and Stanley, MA (2016). Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 728–735. doi:10.1037/tra0000102.CrossRefGoogle ScholarPubMed
Jacobson, N, Newman, M and Goldfried, M (2016). Clinical feedback about empirically supported treatments for obsessive-compulsive disorder. Behavior Therapy, 47, 75–90. doi:10.1016/j.beth.2015.09.003.CrossRefGoogle ScholarPubMed
Kogot, E (2004). The contribution of attachment style to cognitions, affect, and behaviour in achievement settings. Unpublished Doctoral Dissertation, Bar-Ilan University, Ramat Gan, Israel.Google Scholar
Levita, L, Gonzalez Salas Duhne, P, Girling, C and Waller, G (2016). Facets of clinicians’ anxiety and the delivery of cognitive behavioural therapy. Behaviour Research and Therapy, 77, 157–161.CrossRefGoogle Scholar
Mallinckrodt, B and Wei, M (2005). Attachment, social competencies, social support, and psychological distress. Journal of Counselling Psychology, 52, 358–367.CrossRefGoogle Scholar
Meulders, A, van Daele, T, Volders, S and Vlaeyan, J (2016). The use of safety-seeking behaviour in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review. Clinical Psychology Review, 45, 144–156.CrossRefGoogle ScholarPubMed
Meyer, J, Farrell, N, Kemp, J, Blakey, S and Deacon, B (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49–53.CrossRefGoogle ScholarPubMed
Mikulincer, M (1997). Adult attachment style and information processing: Individual differences in curiosity and cognitive closure. Journal of Personality and Social Psychology, 72, 1217–1230.CrossRefGoogle ScholarPubMed
Mikulincer, M (1998). Adult attachment style and affect regulation: Strategic variations in self-appraisals. Journal of Personality and Social Psychology, 75, 420–435.CrossRefGoogle ScholarPubMed
Mikulincer, M and Horesh, N (1999). Adult attachment style and the perception of others: The role of projective mechanisms. Journal of Personality and Social Psychology, 76, 1022–1034.CrossRefGoogle ScholarPubMed
Mikulincer, M and Shaver, P (2007). Contributions of attachment theory and research to motivation science. In Shah, J and Gardener, W (Eds.), Handbook of motivation science (pp. 201–216). New York, NY: Guilford Press.Google Scholar
Mikulincer, M and Shaver, P (2011). Adult attachment and caregiving: Individual differences in providing a safe haven and secure base to others. In Brown, SBrown, R and Penner, L (Eds.), Self-interest and beyond: Toward a new understanding of human caregiving (pp. 39–52). New York, NY: Oxford University Press.Google Scholar
Mikulincer, M and Shaver, P (2016). Attachment in adulthood: Structure, dynamics, and change (2nd ed.). New York, NY: Guilford Press.Google Scholar
Mikulincer, M, Shaver, P and Berant, E (2012). An attachment perspective on therapeutic processes and outcomes. Journal of Personality, 81, 606–616. doi:10.1111/j.1467-6494.2012.00806.x.CrossRefGoogle Scholar
Nash, K, Prentice, M, Hirsh, J, McGregor, I and Inzlicht, M (2013). Muted neural response to distress among securely attached people. Social Cognitive and Affective Neuroscience, 9, 1239–1245. https://doi-org.simsrad.net.ocs.mq.edu.au/10.1093/scan/nst099.CrossRefGoogle ScholarPubMed
Olatunji, B, Cisler, J and Deacon, B (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557–577.CrossRefGoogle ScholarPubMed
Perunovic, M and Holmes, J (2008). Automatic accommodation: The role of personality. Personal Relationships, 15, 57–70.CrossRefGoogle Scholar
Reid, A, Bolshakova, M, Guzick, A, Fernandez, A, Striley, C, Geffken, G and McNamara, J (2017). Common barriers to the dissemination of exposure therapy for youth with anxiety disorders. Community Mental Health Journal, 53, 432–437. doi:10.1007/s10597-017-0108-9.CrossRefGoogle ScholarPubMed
Rholes, W, Paetzold, R and Friedman, M (2008). Ties that bind: Linking personality to interpersonal behaviour through the study of adult attachment style and relationship satisfaction. In Rodewalt, F (Ed.), Personality and social behaviour (pp. 117–148). New York, NY: Psychology Press.Google Scholar
Richman, S, DeWall, N and Wolff, M (2015). Avoiding affection, avoiding altruism: Why is avoidant attachment related to less helping? Personality and Individual Differences, 76, 193–197.CrossRefGoogle Scholar
Roisman, G, Tsai, J and Chiang, K (2004). The emotional integration of childhood experience: Physiological, facial expressions, and self-reported emotional response during the adult attachment interview. Developmental Psychology, 40, 776–789.CrossRefGoogle ScholarPubMed
Sars, D and van Minnen, A (2015). On the use of exposure therapy in the treatment of anxiety disorders: A survey among cognitive behavioural therapists in the Netherlands. BMC Psychology, 3, 26. doi:10.1186/s40359-015-0083-2.CrossRefGoogle ScholarPubMed
Scherr, SR, Herbert, JD, and Forman, EM (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4, 21–29. doi:10.1016/j.jcbs.2014.12.002.CrossRefGoogle Scholar
Slade, A (2016). Attachment and adult psychotherapy: Theory, research, and practice. In Cassidy, J and Shaver, P (Eds.), Handbook of attachment (pp. 759–779). Retrieved from: https://ebookcentral-proquest-com.simsrad.net.ocs.mq.edu.au.Google Scholar
Stewart, E, Frank, H, Benito, K, Wellen, B, Herren, J, Skriner, LC and Whiteside, SP (2016). Exposure therapy practices and mechanism endorsement: A survey of specialty clinicians. Professional Psychology: Research and Practice, 47, 303–311. doi:10.1037/pro0000094.CrossRefGoogle Scholar
Tabachnick, B and Fidell, L (2014). Using multivariate statistics: Pearson New International Edition. Harlow, UK: Pearson Education Limited.Google Scholar
Tolin, D, Hannan, S, Maltby, N, Diefenbach, G, Worhunsky, R and Brady, R (2007). A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. Behavior Therapy, 38, 179–191.CrossRefGoogle ScholarPubMed
Turan, B, Goldstein, M, Garber, M and Carstensen, L (2011). Knowing loves ones’ end-of-life health care wishes: Attachment security predicts caregivers’ accuracy. Health Psychology, 30, 814–818.CrossRefGoogle Scholar
Waller, G and Turner, H (2016). Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy and how to get back on track. Behaviour Research and Therapy, 77, 129–137. doi:10.1016/j.brat.2015.12.005.CrossRefGoogle ScholarPubMed
Wayment, H (2006). Attachment style, empathy, and helping following a collective loss: Evidence from the September 11 terrorist attack. Attachment and Human Development, 8, 1–9.CrossRefGoogle Scholar
Westmass, J and Silver, R (2001). The role of attachment in response to victims of life crises. Journal of Personality and Social Psychology, 80, 425–438.CrossRefGoogle Scholar
Whiteside, SP, Deacon, BJ, Benito, K and Stewart, E (2016). Factors associated with practitioners’ use of exposure therapy for childhood anxiety disorders. Journal of Anxiety Disorders, 40, 29–36. doi:10.1016/j.janxdis.2016.04.001.CrossRefGoogle ScholarPubMed
Winterheld, H (2016). Calibrating use of emotion regulation strategies to the relationship context: An attachment perspective. Journal of Personality, 84, 369–380.CrossRefGoogle Scholar
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