Evaluating the Relationship Between Therapist Negative Beliefs About Exposure Therapy and Delivery Behavior

Therapist negative beliefs about exposure have been identified as a key contributor to underutilization and suboptimal delivery of exposure-however, supporting evidence is derived from laboratory analogue studies and therapist self-report. Benito and colleagues (2021b) completed a training trial that included rigorous coding of videotaped in-session delivery behavior among a sample of therapists (N = 16) who received workshop training followed by ongoing consultation. The present study is a secondary analysis evaluating the relationship between Therapist Beliefs About Exposure Scale (TBES) scores and actual delivery behavior with anxious children/adolescents in the community. Marginally significant findings suggested that lower pretraining TBES scores (i.e., fewer negative beliefs about exposure) were associated with more frequent exposure usage, and that increased use of anxiety-increasing behaviors was related to greater reduction in therapist negative beliefs about exposure over the course of training. Belief levels did not demonstrate a statistically significant difference based on setting (community mental health vs. private practice). Although future studies with larger samples are needed, current findings extend growing evidence highlighting therapist beliefs about exposure as a potential influence on exposure utilization and delivery quality in real-world settings. Dissemination efforts involving the development of training strategies to promote exposure use in community settings are discussed.