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Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat
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Why do clinicians exclude anxious clients from exposure therapy?

Johanna M Meyer1, Nicholas R Farrell1, Joshua J Kemp1

  • 1University of Wyoming, Department of Psychology, Dept. 3415, 1000 E. University Ave., Laramie, WY 82071, USA.

Behaviour Research and Therapy
|February 18, 2014
PubMed
Summary

Therapists often exclude patients from exposure therapy, a proven anxiety treatment, based on client traits that don't predict poor outcomes. This exclusion is linked to therapist anxiety sensitivity and negative beliefs about exposure therapy.

Keywords:
Anxiety disordersCognitive-behavioral therapyDisseminationExposure therapy

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Area of Science:

  • Clinical Psychology
  • Psychotherapy Research

Background:

  • Exposure therapy is effective for pathological anxiety but underutilized.
  • Therapists may exclude clients based on perceived poor response predictors.
  • This exclusion can lead to clients receiving less effective treatments.

Purpose of the Study:

  • To assess therapist likelihood of excluding clients from exposure therapy.
  • To identify client and therapist characteristics influencing exclusion decisions.
  • To evaluate the psychometric properties of the Broken Leg Exception Scale (BLES).

Main Methods:

  • 182 exposure therapists completed an online survey.
  • Surveys included the Therapist Beliefs about Exposure Scale, Anxiety Sensitivity Index-3, and the BLES.
  • The BLES measured likelihood of exclusion based on 25 client characteristics.

Main Results:

  • Comorbid psychosis, emotional fragility, and reluctance to participate were key exclusion factors.
  • Higher therapist anxiety sensitivity correlated with increased exclusion likelihood.
  • Negative beliefs about exposure therapy also predicted greater client exclusion.

Conclusions:

  • Therapist anxiety sensitivity and negative beliefs impact exposure therapy utilization.
  • Certain client characteristics are disproportionately associated with exclusion from exposure therapy.
  • Findings have implications for clinical practice and therapist training regarding exposure therapy.