Fear of Fear: Challenges and Negative Beliefs About Gradual Exposure Use in TF-CBT

Gradual exposure (GE) is a key component of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Initial evidence suggests that negative beliefs about GE may partially explain suboptimal exposure implementation.

The current study sought to evaluate GE negative beliefs and determine what professional factors might contribute to them.

Participants (N = 742; 85.71% cisgender women; 67.25% White; M _age(SD)=36.06[10.47]) who recently engaged in TFCBTWeb2.0 filled-out questionnaires assessing their views of GE within TF-CBT, evidence-based practice (EBP), TF-CBT implementation, and training experiences. Beliefs about GE and difficulty implementing TF-CBT were compared across various professional characteristics (e.g. TF-CBT experience, student status). Structural equation modeling (SEM) was utilized to evaluate which professional characteristics may relate to negative beliefs about TF-CBT GE.

The most negatively rated TF-CBT GE beliefs included concerns about youth experiencing negative effects from exposure, endangering confidentiality, and provider vicarious trauma. Participants who used TF-CBT with a patient generally had less negative GE beliefs compared to those who had never used TF-CBT. In the SEM analysis, general TF-CBT negative beliefs and beliefs about EBP were significant predictors, such that participants who reported more general negative beliefs about TF-CBT and EBP were more likely to report stronger negative GE beliefs.

These results suggest that negative beliefs about GE can be a target during training to improve TF-CBT implementation, and that novel training approaches (e.g. experiential training) that specifically address negative GE beliefs are needed given the lack of currently available trainings in this domain.